@Article{chd.12611,
AUTHOR = {Michele M. Pasierb, Josiah M. Penalver, Margaret M. Vernon, Bhawna Arya},
TITLE = {The role of regional prenatal cardiac screening for congenital heart disease: A single center experience},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {13},
YEAR = {2018},
NUMBER = {4},
PAGES = {571--577},
URL = {http://www.techscience.com/schd/v13n4/39026},
ISSN = {3071-1738},
ABSTRACT = {<b>Background:</b> Accurate prenatal diagnosis of congenital heart disease (CHD) allows for appropriate
delivery and postnatal management. Geographic constraints limit access to fetal cardiology subspecialists. In our approach, general pediatric cardiologists are first line in regional prenatal cardiac
screening. We aim to demonstrate the utility of this approach in diagnosing CHD requiring cardiac
interventions within 30 days of life.<br/>
<b>Methods:</b> This is a retrospective review of fetal echocardiograms performed at Seattle Children’s
Hospital regional cardiology sites (SCH-RC) from December 2008 to December 2015. Referrals to
Seattle Children’s Hospital Prenatal Program (SCH-PNP) were evaluated for referral timing, indication, diagnostic accuracy, and postnatal care. Diagnostic accuracy was determined using the initial
postnatal echocardiogram as the gold standard. Major discrepancy was defined as one resulting in
change in surgical management.<br/>
<b>Results:</b> Of 699 fetuses evaluated at regional sites throughout Washington and Alaska, a small
subset (n = 48; 6.9%) required referral to SCH-PNP. Need for relocation was confirmed in 31 subjects, of which 27 required cardiac intervention within 30 days of life. Of those not referred to
SCH-PNP (n = 643, 91.9%), none required neonatal cardiac intervention. There were 22 regional
diagnostic discrepancies (31% major, 7% minor). Referral to SCH-PNP improved diagnostic accuracy (2% major, 0% minor).<br/>
<b>Conclusions:</b> Regional prenatal cardiac screening demonstrated 100% sensitivity and 98.9% specificity for identifying critical CHD. Utilizing regional pediatric cardiologists as first line in prenatal
screening in geographically remote regions may improve access to care and outcomes in neonates
with critical CHD while improving resource utilization.},
DOI = {10.1111/chd.12611}
}